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HomeMy WebLinkAbout1155 SOUTH DIAMOND BAR BLVD (153) -..� . _ __ ,-. ._ ..,_�_._. �.:...,_ .-. -- ,� r WORKERS'COMPENSATIONDECLARATION � 7eA663 �o�e�, . � =APPLIC�4TION�FOR ELECTRICAL PERMIT � I nereby offirm tha� I have a cerlifimte of wnsen': fo self ,�E-806G ' s �nwre,-o�o ce�t�fica+e of worke�s'Compensation I�su�a�ce, COUNTY OF LOS ANGELES BUILDING.AND SAFETY �, or a certified copy ther of(Sec.3800.Lab.C.) - T-- Poliry N � p' Company���_.������ FOR APPLICANT�T6 FllllN .. . . JOB � n. - � - � Certified mpy is hereby furnished. New Residential Bldgs.8 Pools EACH NQ FEE A�DRESS �/' � Certifled copy is filed with the ounty b�liding inspea 1 &2-Fam�!y,Sq.Ft. S = S LOCALITY ' � tion dep t t. >/ M�It'i-fomily Sq.Fi. CRO5555T. � Date y r �Applimnt � °� Residential Swimming Pools OWNEF OR - �, I FIRM NAME CERTIFICATE Of EXEMPTION FROM ORKERS' Outlets:Rec_Light_Sw._I I MAIL COMPEN5.4TION IfVSURAN E ADDRESS FirSt 20 (This section need noT be compleTed if fhe work involved by Total No. Additional � CITY Tel.N�. fhe permif is fer one hundred dollars(5100)or less.) PLAN CHECK !certify that in the performance of ihe work far which this � qppuCANT ,� � permit is issued,I shall not employ any person in any manner so as to become subiect to the Workers'Compensation Laws. Lighting Pixtures First 20 � ADDRE55- j Total No. Additiono! GTY Tel.No. �.� _ �ate App�kant Fixed Appliances No+Over 1 HP PERMI7 NOTICE TO�APPLICANL If, after making this Cerrificate of Ran e—Hearer_D.W. _ APPLiCANi � Exemption, you should become subjeU �o �he Workers' 9 .. Compensatlon provisions of the Labor Code,you must forth- Oven _Dryer —W.M.— ADDRE55 ..�� �� wilh comply wiih such provisions or this permit sholl be Top �FAU —W.H._ deemed revoked. Hood _Fan _Orher_ CITY Tel.No. LICENSED CONTRACTORS DEQARATION tICENSE OR t Disp. —Room Air Cond. — REG.NUMBER ��Co+�'� Class.�' I herehy affirm that I am licensed�nder provisions of Chapter 9 J a (wmmencing with Section 7000)oF Division 3 of the Business power Apparotus&Large Applionces �ISTRICT NO. e PROCESSED BY Q. and Professions Code,and my license is in full force and effect. /� U Size&Type HP,KW,KVA,or KVAR � License Nomb �� ���� Lkj Closs� FINAL � �' Up to 1 Ind. DATE � � Over 1 to 10 Ind. VALIDATION � Coniractor ��1��Dafe������ Over 10 to 50 IncL L.Vti ❑ FINAL a I om exempl un er Sec Over 50 to 100 Inc, gY � B.&P.C.for this reason Over 100 . . ,. .. . . . � Dote: Services,Swbd.,MCC&Poneiboards ► �-- 0-200 Amp.Under 600 V Signoture 201 -1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption tor Reg.Moint.Eled. i � SINGLE FAMILY Temp.Power Pole&Appurtenances � !,� HOME OWNER-BUILDER�DECLARATION � Sign with One Bronch Circuif I here6y affirm that I am ezempt from ihe Contractor's License qdditiono�Sign Branch Circuits a � c 3 i 7.2 A law for the following reason(Section 7031.5, 6usiness and . ��,+{ �/� Professlons Code): � � + �- Misa Conduits&Condudors i �� s' ���� I,os owner of Ihe property,will do the work and the �� structure is nm intended o�offered for sale (Section Oiher(See Complete Fee Schedule)_ � � � ���JC� 7044,Business and Professions Code). . . __ CONSTRUCTION LEN�ING AGENCY C e s r�'"�� I hereby affirm tho�ihere is a construction lending agenry for �� � C.L�r,j2� ihe performonce of ihe wa:k far which ihis permlt is issoed pERMIT fEE (Sub-To�a�1 !� J) (Sec 3097,Civ.C.). PLAN CHEGKING FEE Lender's Nome � �� � ��� PERMIT ISSUING PEE �� Lender's Address �y� I certify ihai I have read lhis application and state fhpt�he TOTAL FEE �`� s� above information is correct I agree to mmply with all Cauniy - � �� '��- -� -- --�� '��"'°' '�"-� � - ��� �-�` ' � - �� �� - ordinanc�opd State lows regu ting Electricol wiring, and hereby yuthorize represent ives f fhis Counry to enter upon rhe a6¢ve- entioned pro ry f�mspechon pur ose;. ` ! �/ tls SEE REVERSE FOR EXPLANATORY LANGUAGE.. � / s/1' ... . .. �-u-sv Sign Wr .,r.inee a�e _.._—__—•�wes::+a�.z� .._._"._",..,.m....-......._........-.��,...-..,w-.,..,.�.:,.l..�,.-�....,.9��-_ - __�.,�-a-a:.F,.a.�.- _. � _._. __.__. ___._.__.___.�.__ - __- ..._ ,.. _ . � ._ 7 �_; � ��- .,:. ..:�_.�: . .�:.__. ;__ .._ � _ _____.; .;�.. �.. .,. �, ' .� . . , _...�.._w.__....___.,_��.___. _. .�.�.. _.... ...�__ . ,.-..,-r,�.; . ..<. �- ._. � .,: � ,,. . .. - . . _.__�._ _._ ,__.�-- -- _... _ ___._._.__.._� .. _.. �� . . .r,� : �: .. _._..._..._....._._---...�_._;____.__ ,___._.__ ._._______.._.. _ - . ;;`<�,s: , ,. _,....,_.., i -�� . .•:.:'� �ro:�e. ..:,:i, .. .j . . . ... . .__ ...:_.__'"". __�...,._.., ... ."'""_'__.. . . , . . . .- [' i'_. - ""' .. . ,.,-3., . ... .. . .._ ._ ..: ..._._.� ` ; � r + . : E. , 4_ �, . , f .. . , _ . .� . _. . ..._ ......_......._,....._ __. «_., _._t.. �_..__�.�_�._. .._� _, . .._.: � .. �'..� ..,.-Y.l. 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